Zhang Yi, Shi Ke, Zhu Bingbing, Feng Ying, Liu Yao, Wang Xianbo
Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing 100054, China.
Biomedicines. 2024 Sep 9;12(9):2048. doi: 10.3390/biomedicines12092048.
Hepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF) is associated with pronounced systemic inflammation, and neutrophil extracellular traps (NETs) are key components of this response. The primary objective of this study was to establish an NET-related scoring system for patients with HBV-ACLF. A prospective training cohort of 81 patients from the Beijing Ditan Hospital was included. The concentrations of NET markers (cell-free DNA, myeloperoxidase DNA [MPO-DNA], and citrullinated histone H3) in peripheral blood were quantified. Random survival forest, LASSO regression, and multivariate Cox regression analyses were used to identify prognostic factors associated with 90-day mortality in ACLF patients and develop a nomogram for visualization, which was followed by evaluation in a validation cohort ( = 40). NET-related marker levels were significantly higher in the non-survival group than in the survival group ( < 0.05). The NET score was constructed by combining MPO-DNA, neutrophil-to-lymphocyte ratio, and age data. The score's diagnostic effectiveness, assessed by the area under the curve, yielded values of 0.83 and 0.77 in the training and validation sets, respectively, markedly surpassing those of other established models ( < 0.05). In both groups, the 90-day mortality rates were 88.8% and 75.0%, respectively, for patients categorized as high risk and 18.0% and 12.5%, respectively, for those classified as low risk.
乙型肝炎病毒（HBV）相关慢加急性肝衰竭（ACLF）与明显的全身炎症相关，中性粒细胞胞外陷阱（NETs）是这种反应的关键组成部分。本研究的主要目的是为HBV-ACLF患者建立一种与NET相关的评分系统。纳入了来自北京地坛医院的81例患者的前瞻性训练队列。对外周血中NET标志物（游离DNA、髓过氧化物酶DNA [MPO-DNA]和瓜氨酸化组蛋白H3）的浓度进行了定量。采用随机生存森林、LASSO回归和多变量Cox回归分析来确定与ACLF患者90天死亡率相关的预后因素，并绘制列线图以进行可视化，随后在一个验证队列（n = 40）中进行评估。非生存组的NET相关标志物水平显著高于生存组（P < 0.05）。通过结合MPO-DNA、中性粒细胞与淋巴细胞比值和年龄数据构建了NET评分。通过曲线下面积评估，该评分在训练集和验证集的诊断效能值分别为0.83和0.77，明显超过其他已建立模型的值（P < 0.05）。在两组中，高危患者的90天死亡率分别为88.8%和75.0%，低危患者的90天死亡率分别为18.0%和12.5%。
